Biomedical subjects

Dominique Luton

Publications and source records attributed to Dominique Luton.

6 recordsLinked to original sources

PubMed2003

Ventricular dilatations.

INTRODUCTION: Ventricular dilatation is generally defined on ultrasounds (US) or MRI as an atrium larger than 10 to 12 mm on axial or coronal planes. After 22 weeks, this measure is independent of the term. METHODS: In the view of the prognostication, it is of utmost importance to not only calculate the width of the ventricles but also to estimate the progression of the ventriculomegaly, and to look for associated structural or genetic anomalies. In this respect, it is essential to study the shape, thickness, echogenicity or signal (on MRI) of the ependymal lining, to appreciate the echoic or radiological characteristics of the ventricular content, to search for brain malformations, to calculate the biparietal diameter, head circumference and width of the subarachnoid spaces, to know the karyotype and to search for fetal infection or extracranial malformation. Complete US evaluation, MRI, and amniocentesis must therefore be part of the routine check-up of these fetuses. DISCUSSION: The prognosis is still debated. It is usually considered to be poor in cases of associated malformations or brain insult, tri- or tetraventricular enlargement and karyotype anomalies. On the contrary, it is generally considered as good when ventriculomegalies are isolated, biventricular, stable, slowly evolving or regressive. CONCLUSION: The relationship between the size of the ventricles and the uni- or bilateral character of the dilatation are still a matter of debate.

Amniocentesis↗

PubMed2003

Six hundred and ten breech versus 12,405 cephalic deliveries at term: is there any difference in the neonatal outcome?

OBJECTIVES: To compare neonatal morbidity of breech and cephalic deliveries at term. STUDY DESIGN: Cohort study of 610 consecutive singleton breech presentations and 12,405 consecutive singleton cephalic presentations in term between 1992-1998. Five hundred and fourteen breech and 11,989 cephalic presentations were candidates for vaginal delivery, of which 407 (79%) breeches and 11,265 (94%) cephalic delivered vaginally. RESULTS: Neonatal intensive care admissions were significantly greater for breech than cephalic vaginal deliveries (2.7% versus 0.25%, P = 0.000), but newborn intensive care admission and mortality were equally distributed between the two groups. CONCLUSIONS: A low caesarean rate is possible (21% beech and 6% cephalic). Neonatal morbidity was equal in the two populations. Admission to neonatal intensive care was significantly more frequent for caesarean section than for vaginal delivery in the cephalic group and equal in the breech group. This study justifies our obstetrical policy and the realisation of a trial in several centres similar in terms of perinatal management.

Breech Presentation↗

PubMed2002

Differences in management and results in term-delivery in nine European referral hospitals: descriptive study.

OBJECTIVE: To compose obstetric interventions around Europe. STUDY DESIGN: A survey of obstetric practices, logistics and statistical outcomes in nine tertiary referral hospitals in Europe between November 1999 and October 2000. RESULTS: There was wide variation in the management of pre labour rupture of the membranes at term, methods of analgesia, induction of labour, and mode of cephalic and breech delivery. Midwives practised normal deliveries at only three sites. Rates of epidural analgesia varied from 0% in Perugia to 98% in Barcelona, instrumental delivery from 3% in Perugia to 40% in Barcelona, episiotomy from 9.7% in Uppsala to 58% in Perugia, caesarean section before and during labour from 12% in Paris to 32% in Athens, vaginal breech delivery from 15% in Barcelona to 70% in Paris. The percentage of primipara varied from 40% in Uppsala to 65% in Perugia; birth weight under 2500g from 5% in Uppsala to 23% in Amsterdam, over 4000g from 3.1% in Athens to 22% in Uppsala and gestational age less than 37 weeks from 6% in Dublin to 26% in Amsterdam. CONCLUSION: There are considerable differences in obstetric practices without any major difference in maternal and perinatal mortality.

Analgesia, Epidural↗

PubMed2002

Down syndrome maternal serum marker screening after 18 weeks' gestation.

Women having access to prenatal care late in pregnancy may still wish to benefit from maternal serum screening for Down syndrome. Therefore, we established reference values for alpha-feto protein (AFP) and free beta-human chorionic gonadotrophin (beta-hCG), and assessed the diagnostic value of maternal serum marker screening at 18-35 weeks' gestation based upon a series of 4072 sera from unaffected pregnancies and 118 sera from pregnant women with fetuses affected by Down syndrome. Using a 1/250 risk cut-off, a detection rate of 72.9% (95% CI = 71.5-74.3%) was achieved with a false-positive rate of 7.51% (95% CI = 6.71-8.3%). This was not significantly different from the percentages observed in our 14-17 weeks routine screening (50 596 patients): 71.9% (95% CI = 71.5-72.3%) and 6.48% (95% CI = 6.28-6.68%), respectively. Detection and screen-positive rates were, respectively, 51.3% (95% CI = 35.6-67.0%) and 5.95% (95% CI = 5.12-6.68%) in women aunder 35 years of age, and 84.8% (95% CI = 76.9-92.7%) and 24% (95% CI = 20.7-27.3%) in women aged 35 years and over. In conclusion, maternal serum marker screening is feasible at 18 weeks' gestation and later, which may be of interest in selected cases.

Adult↗

PubMedDate not supplied

Prenatal diagnosis of pial-superficial arteriovenous malformation.

In the newborn, cerebral pial arteriovenous malformation has been recognized as a cause of congestive heart failure. Prenatal diagnosis allows early medical treatment of cardiac failure and increases the chance of successful neuroradiological intervention. This paper highlights the importance of careful prenatal cerebral examination in cases of cardiac ventricle enlargement.

Adult↗

PubMedDate not supplied

Etiology and outcome of fetal echogenic bowel. Ten years of experience.

OBJECTIVE: To assess the frequency of certain etiologies in fetal echogenic bowel and the related pregnancy outcome. STUDY DESIGN: A retrospective study including 215 cases. Ultrasound findings included bowel abnormality, malformations, growth retardation and Doppler abnormalities. Amniocentesis was performed in 196 cases to screen for abnormalities in karyotype, cystic fibrosis gene and infection. The color of amniotic fluid and a history of first-trimester bleeding were also noted. Outcome according to different etiologies was reported. RESULTS: 112 cases (57%) had a known etiology, which included chromosomal abnormality (7%), infection (4%), cystic fibrosis (1.5%), bowel abnormality (3%), bleeding or stained amniotic fluid (11%), Doppler abnormality (14%), malformation (16%) and miscellaneous (0.5%). Pregnancy was terminated in 39 cases and fetal demise complicated one third of the cases (13) of severe growth retardation. CONCLUSION: Fetal echogenic bowel should be investigated and a careful follow-up is necessary if there is associated Doppler perturbation or growth retardation.

Female↗